The invention relates to a suturing instrument for remotely joining the edges of a wound within the body of a patient.
Such a surgical instrument is known, for example, from U.S. Pat. No. 4,935,027 (Yoon); it is suitable for conventional as well as minimal invasive (MIC) surgery. It comprises outer and inner tubes which are movable axially relative to one another and which carry at their distal ends (remote from the operator and to be inserted into the body of a patient) two pliers or forceps-like jaws or hooks which are hollow and are received within the suturing material. This U.S. patent shows an arrangement wherein both jaws or hooks are movable or One jaw is stationary and the other is movable. At the proximal end (the end next to the operator) there is a handle portion which is connected to the inner tube and to the outer tube for moving the jaws or hooks relative to one another. Within the inner tube there is the supply passage for the suturing material.
With this suturing instrument however, only single-knot sutures can be applied wherein each suture must be secured with a knot movable toward the tissue. The applying of the knots is complicated and time-consuming. Furthermore, the tissue is penetrated not only by the suturing material but also by the hook.
DE 31 41 647 A1 discloses a surgical instrument for the application of clamps. This instrument includes an elongated body with a handle portion at the proximal end. At the distal end of the elongated body there is a stationary support jaw with a recess for locking the clamp. Furthermore there is at the distal end of the elongated body a movable engagement jaw with the clamp applicator. The engagement jaw is mounted to the body so as to be movable back and forth in the direction of the stationary support jaw. The instrument also includes a drive mechanism for operating the engagement jaw and the clamp applicator. The movable engagement jaw includes a channel for feeding a wire thereto and is provided, at the channel exit, with a cutter which is movable back and forth in a plane normal to the channel for cutting off wire pieces and which is operatively connected to the drive mechanism.
However this instrument is relatively large and already because of its size and design is not suitable for minimally invasive surgery.
Another suturing instrument is known from EP 01 74 843 A2. This suturing instrument includes a block defining a one-sided open cavity receiving a suturing material support structure which can be operated by a handle portion at the proximal end of the elongated instrument. There is further a channel extending into the cavity which receives a needle with an eye through which the suturing material passes. The channel is arranged opposite the suturing material support structure. Furthermore a suction structure extends into the cavity. The block is placed onto the tissue to be sutured in such a way that the cavity is closed by the tissue. Then the cavity is evacuated by the suction structure such that the adjacent tissue enters the cavity. Then a suture is applied by means of the needle and the suturing material support structure and finally the application of vacuum by the suction structure is interrupted so that the tissue returns to its original location. This suturing instrument however is only suitable for stitching over closed tissue since only then can it be pulled into the cavity by the suction structure. Suturing of the edges of wounds is not possible.
DE 29 27 143 A1 discloses a surgical instrument for the application of sutures which is designed particularly for the attachment, by stitching, of heart pace makers. This instrument comprises an instrument shaft with a proximal end and a distal end to be inserted into the body of a patient. The instrument shaft includes two channels which receive sections of a wire-like suturing material. At the distal end these channels are shaped in such a manner that the suturing material assumes an annular shape. At the beginning of the operation the electrode of the pace maker is attached to the distal end of the instrument shaft. A two-piece handle portion is used to advance the suturing material and to disconnect the electrode. The instrument has no jaws. It might be utilized for suturing tissue edges but only under most favorable conditions.
U.S. Pat. No. 1,449,087 discloses a plier-like suturing apparatus with two curved jaws at its distal end of which each is provided with a clamping surface. Each jaw includes a curved channel which ends at the clamping surface. By means of a piston a surgical stitching needle with stitching material is moved through the curved channels and through the tissue disposed between the clamping surfaces.
EP-A-0 121 362 discloses a clamping arrangement with opposite clamping jaws of which one includes a channel receiving a straight piece of stiff suturing material and the other has a curved channel into which the suturing material is moved through tissue disposed between the clamping jaws whereby the suturing material is bent to an annular shape.
It is the object of the present invention to provide a suturing instrument without the disadvantages of the known instruments, with jaws which do not penetrate the tissue and which permits the application of several sutures with a single operating procedure. The instrument should permit suturing of wound edges in conventional surgery as well as in minimally invasive surgery. It should therefore be slim enough to be movable and operable through an access sleeve (Trokar sleeve).